We characterized antibiotic resistance and virulence of uropathogenic Escherichia coli (UPEC) strains isolated from urinary tract infections (UTIs) in patients hospitalized in urology departments. A prospective multicentre study was initiated from March 2009 and lasted until February 2010 in French urology units. All patients with asymptomatic bacteriuria (ABU), acute cystitis, acute pyelonephritis or acute prostatitis in whom UPEC was detected were included. Antimicrobial resistance and virulence factors were compared among the different groups. To identify Abbreviations: ABU, asymptomatic bacteriuria; ESBL, extended spectrum b-lactamase; QRDR, quinolone resistance-determining region; rep-PCR, repetitive-PCR ; UPEC, uropathogenic Escherichia coli; UTI, urinary tract infections; VF, virulence factor. 000247 ã 2016 The Authors Printed in Great BritainJournal of Medical Microbiology (2016), 65, 530-537 DOI 10.1099 independent associations between virulence markers and the risk of UTI, we used a multivariate logistic regression. We included 210 patients (mean age: 65.8 years; 106 female). Episode of UTI was community acquired in 72.4 %. ABU was diagnosed in 67 cases (31.9 %), cystitis in 52 cases (24.7 %), pyelonephritis in 35 cases (16.7 %) and prostatitis in 56 cases (26.7 %). ABU was more frequent in patients with a urinary catheter (76.1 vs 23.9 %, P<0.001). The resistance rate was 7.6 and 24.8 % for cefotaxime and ciprofloxacin, respectively. UPEC isolated from infections belonged more frequently to phylotypes B2 and D (P =0.07). The papG allele II and papA, papC, papE, kpsMTII and iutA genes were significantly more frequent in infecting strains (P<0.05). In multivariate analysis, strains susceptible to ciprofloxacin were significantly associated with papG allele II (P=0.007), kpsMTK1 (P<0.001) and hlyA (P<0.001) compared with the ciprofloxacin-resistant strains. To the best of our knowledge, this is the first study evaluating the antibiotic resistance and virulence features of UPEC isolated from patients hospitalized in urology departments. High resistance rates were observed, notably for ciprofloxacin, highlighting the importance of a reinforced surveillance in this setting. INTRODUCTIONUrinary tract infections (UTIs) are among the most common community-acquired and nosocomial infections (Foxman, 2003;Lavigne et al., 2007). These infections are rarely directly associated with a patient's death. However, they are responsible for an increased risk of aggravation of comorbidity and healthcare-associated costs. Such infections are also responsible for significant use of antibiotics, with implications for bacterial ecology and the risk of collateral damage. Among bacterial species implicated in UTIs, uropathogenic Escherichia coli (UPEC) is the most common. In recent decades, multidrug-resistant UPEC has led to major difficulties treating infected patients. Although many recent studies have investigated UPEC virulence, few data are available on antibiotic resistance and the virulence features of these strains di...

The value of early cleavage (EC) assessment is still being debated. The aim of this prospective study was to examine the predictive value of EC assessment performed exactly 26 h after insemination by IVF or intracytoplasmic sperm injection (ICSI) in a programme of elective single embryo transfer (SET) performed at day 2. If day 2 scoring demonstrated several embryos with high implantation potential, an EC embryo was transferred preferentially. EC was assessed only during normal laboratory hours so that there were two groups: EC assessed, and EC not assessed, the latter being the control. A total of 277 elective SET were performed in women under 37 years undergoing their first IVF or ICSI cycle (mean age 30.5 years, range 21-37). The overall clinical and ongoing pregnancy rates were 40.1% (111/277) and 32.9% (91/277) respectively. Significantly higher overall clinical and ongoing pregnancy rates were obtained after transfer of an EC embryo than a non-EC embryo: 49.4 versus 33.3% (P < 0.05) and 42.4 versus 25.9% (P < 0.02) respectively. However there was no significant difference between the EC assessed and control groups: 40.4 versus 39.3% and 33.2 versus 32.1 respectively. These findings confirm the value of EC assessment for selection of embryos with high implantation potential.

OBJECTIVE: To evaluate the prevalence of fecal carriage of vancomycin-resistant enterococci (VRE) by patients hospitalized in intensive care units from 24 French general hospitals. METHODS: Rectal swabs were obtained from 647 patients hospitalized in intensive care units during the month of June 1994 and plated on agar medium selective for vancomycin-resistant enterococci. The glycopeptide resistance phenotypes and genotypes of the enterococci detected were characterized. RESULTS: Thirty-two of 647 patients (4.9%) carried VRE. Thirteen strains (2%) were identified as Enterococcus faecium and 19 (2.9%) as Enterococcus gallinarum or Enterococcus casseliflavus. None of these strains was highly resistant to gentamicin. The E. gallinarum and E. casseliflavus strains contained the vanC1 and vanC2 genes, respectively. The E. faecium strains were highly resistant to vancomycin and teicoplanin and carried the vanA gene. No infection due to VRE was observed during the study period. Pulsed-field gel analysis of total DNA following digestion with SmaI or KspI from 13 VanA-type E. faecium strains revealed intra- and inter-hospital strain heterogeneity. However, the finding of isolates with indistinguishable pulsed-field types within the same ward and in two medical centers suggests patient-to-patient transmission or a common source. Four E. faecium strains were isolated within 48 h after admission of patients. CONCLUSIONS: These results indicate that VRE form part of the normal flora of patients and that, despite the actual scarcity of infections due to VRE, there is a potential risk for dissemination of these strains in French hospitals.

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